［摘 要］ 目的:探讨奥布卡因与布比卡因混合液联合角膜接触镜对PRK术后疼痛的治疗作用。 方法:①实验部分：将8只健康家兔双眼角膜上皮刮去，设左右眼对照，分别滴奥布卡因-布比卡因混合液（奥-布混合液）与生理盐水，观察角膜上皮的愈合速度；②临床部分：选择双侧眼屈光状态基本相等的PRK手术病人80名，术后配戴角膜接触镜，设左右眼对照，分别滴奥-布混合液与生理盐水，观察术后疼痛程度以及角膜上皮愈合速度。 结果:①兔左眼（实验眼）整体角膜上皮愈合时间为114小时，兔右眼（对照眼）为111.6小时，二者差异没有显著性。②71例患者诉左眼（实验眼）疼痛明显减轻，6例诉双眼均无明显疼痛，3例诉均有明显疼痛；三天内角膜上皮完全愈合率左眼为96.25%，右眼为97.5%，二者差异无显著性。结论：奥-布混合液基本不影响角膜上皮愈合，有明显的止痛作用，配合角膜接触镜的使用，对PRK术后以及角膜上皮擦伤后止痛会很有帮助。
［中图分类号］ R772.2；R779.62 ［文献标识码］ B
［文章编号］ 1008-1801(2000)04-0204-03
The combined use of a combination of topical oxybuprocaine and bupivacaine drops and contact lens for pain relief after PRK
ZHANG Guang-ming,MAI Cai-keng.
(Department of Ophthalmology,Union Hospital of Tongji Medical University, Wuhan 430022)
Abstract： Objective：To evaluate the effect of the combined use of a combination of topical oxybuprocaine and bupivacaine drops and contact lens for pain relief after PRK.Methods：①The corneas in eight normal rabbits were scratched, and then treated with a combination of topical oxybuprocaine and bupivacaine drops to one eye and placebo to the other eye to observe corneal epithelial wound healing. ②80 patients with the similar diopter in both eyes were performed photorefractive keratectomy（PRK） and used soft contact lens. To observe postoperative pain degree and speed of corneal epithelial wound healing, a combination of topical oxybuprocaine and bupivacaine drops was used to one eye and placebo to the other eye.Results：①Duration of corneal epithelial wound healing was 114 hours in the treatment group and 111.6 hours in the placebo group. No significant difference was in both groups. ②Pain was dramatically reduced in the treated eyes of 71 patients and in both eyes of 6 patients. There was marked pain in both eyes of 3 patients. The rate of corneal epithelial healing within 3 days after PRK was 96.25% in the treatment group and 97.5% in the placebo group. No significant difference was in both groups.Conclusion：A combination of topical oxybuprocaine and bupivacaine drops rarely affects corneal epithelial wound healing and markedly relieves postoperative pain. In conjunction with contact lens, it is helpful for pain relief after PRK and corneal abrasion.
Key words： laser surgery; cornea/surgery; contact lens/therapeuic use; pain; oxybuprocaine/therapeutic use; bupivacaine/therapeutic use
准分子激光角膜切削术(PRK)后疼痛，一直是人们关注的问题。本文试用一种局麻药混合液联合角膜接触镜来治疗PRK术后疼痛，观察它对角膜上皮愈合的影响和止痛的效果。
1 材料和方法
1.1 动物实验部分
1.1.1 材料：健康家兔8只（同济医科大学实验动物部提供）,体重2～3kg，雌雄兼用，外眼检查正常。25g/L布比卡因+20g/L奥布卡因混合液。
1.1.2 方法：①8只家兔均用氯胺酮30mg/kg、氯丙嗪25mg/kg，同时作臀部肌肉注射进行麻醉，用手术刀完整刮除双眼角膜上皮，避免损伤前弹力层。②左眼滴25g/L布比卡因+20g/L奥布卡因混合液，1次/小时，每天10次；右眼滴90g/L生理盐水作对照，滴药频率二者相同。另外，双眼滴25g/L氯霉素，4次/天，以防感染。③术后24小时，开始用裂隙灯显微镜观察角膜上皮愈合情况并记录。
1.2 临床部分
1.2.1 资料：在本院选择双眼屈光状态基本相等的PRK手术病例80例（共160眼），其中，低于-4.00D 54只眼，-4.00～-8.00D 88只眼，高于-8.00D 18只眼，年龄在18～40岁，其中男59例，女21例。
1.2.2 方法：①将25g/L布比卡因+20g/L奥布卡因混合液分装在无菌塑料瓶中，标上左眼；将90g/L生理盐水分装在同样的塑料瓶中，标上右眼。②患者双眼行PRK术后，均配戴角膜接触镜，滴30g/L泰利必妥眼水，4次/天，同时嘱咐患者按瓶上的标记，左眼滴布-奥混合液，右眼滴生理盐水，1次/1～2小时。③每天在裂隙灯显微镜下检查角膜上皮愈合、上下眼睑与球结膜水肿程度，以及查问疼痛情况，并作记录。
2 结果
2.1 实验部分 实验组：术后4天角膜上皮愈合有2眼，术后5天角膜上皮愈合有5眼，术后6天角膜上皮愈合有1眼。对照组：术后4天角膜上皮愈合有2 眼，术后5天角膜上皮愈合有6眼。实验组与对照组兔角膜上皮愈合时间见表1,通过符合等级轶和检验，P＞0.05, 二者差异无显著性意义。
表1 兔角膜上皮愈合时间 (小时)
表2 术后角膜上皮缺损面积平均值 (mm2)
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